Body-focused repetitive behaviour (BFRB) is the umbrella-term label given to any obsessive, compulsive, repetitive self-grooming behaviour which causes damage to an individual’s body and/or appearance. BFRBs come under the category of impulse-control behaviours, and can become so preoccupying and debilitating that they may interfere with an individual’s quality of life to a large – and rather misunderstood – degree.
The main BFRBs are dermatillomania (skin-picking) and trichotillomania (hair-pulling). Other common behaviours in the category range from nail-biting and lip-chewing, to cuticle-peeling and blemish-squeezing.
I have struggled with some of these body-focused repetitive behaviours (BFRBs) for as long as I can remember. As a child and teenager, I always had my fingernails in my mouth; my cuticles became chewed and picked to the point of bleeding and infection. As a young teenager, I became obsessed with plucking my eyebrows to the extent I barely had any left for significant periods of time. As an adult, I continue to struggle; my biggest difficulty being with picking the skin around my fingernails, and attacking the keratosis pilaris (a pretty common skin condition) on both my upper arms and legs.
Recently I have be struggling with the picking to no end, and to be honest it’s really been getting me down these last few weeks. I have constantly new or healing sores from all the picking, and a growing collection of small circular scars as a result, too. I can end up losing hours of each day as a slave to the picking, and feel trapped within a battle between my brain and body: Even though I am so desperate to STOP the behaviours, I am finding it simply impossible. Worst of all the consequences is the shame, helplessness and frustration I feel as a result, as well as the inevitable perpetuation of my low self-esteem, self-consciousness, self-hatred and self-disgust.
I have been researching on the topic a fair amount in order to try and understand exactly what I am experiencing, and why. I have been relieved to find that I relate to multiple people and sources on the Internet and in the world. To know that I am not alone in the BFRB struggles certainly reduces the shame and stigma I have felt in the past. I genuinely hadn’t realised that others have such similar struggles, obsessions and nuances as I do in this way.
Here are a few things that have struck me in my recent reading around BFRBs:
- It is common for family members and friends to grossly misunderstand that BFRBs are not just habits that can be broken. I, like many others, have been judged and shamed by those around me who fail to comprehend the intensity of the compulsion to engage in behaviours which seem so unacceptable and off-putting to others. My mother often tells me that she feels she is “sitting next to a monkey” because I am always picking at myself. Similarly, my sister tells me that I am disgusting and shouts at me to remove myself from the room. In response to judgments such as these, my shame, anger (self-directed) and urge to hide away are reinforced.
- People are under the false impression that we can just stop, man up, or that we simply need more willpower. This is not the case; if it were so simple, if it were a choice, we would stop in the click of a switch. BFRBs become diagnosable as a disorder when the sufferer finds that no matter how hard they try to stop, no matter how many times they have attempted to do so, they just cannot seem to get a grasp on a prolonged and liberating remission.
- I, like many others, tend to engage in the BFRBs during one of two states of mind. The first is during periods of heightened emotion; for me specifically with anxiety and fear. During these moments, the BFRBs act as self-regulating and soothing mechanisms, and can lessen the intensity of whatever it is I am experiencing dramatically. The second state is within a more dissociative, robotic frame of mind. Oftentimes, whilst feeling on auto-pilot, the BFRBs come into play without any conscious or intentional awareness.
- My BFRBs, like many other people’s, are an attempt to “fix” or “perfect” an irregularity or imperfection on my body, such as a loose nail or uneven patch of skin. Ironically, engaging in the behaviour – which involves attacking myself in some form – inevitably worsens the appearance of the area I am attempting to rectify. In trying to physically correct myself, I end up creating even more damage. This then leads to an increased desire to “fix” the worsening problem, which followed by the corrective action, leads to consequent further self-destruction. It is an endless and self-perpetuating cycle, and in my opinion one which is accompanied by distorted and even body-dysmorphic thinking.
- As I have experienced, BFRBs sound pretty darn hard to treat and fully recover from. Although there are a few specific therapies targeted to help combat these difficulties, BFRB disorders remain largely stigmatised, misunderstood and dismissed within society.
I am going to start trying to combat my own skin- and nail-picking BFRBs in two ways I have discussed with my therapist. Firstly, by applying hand lotion every time I notice the urge to pick at my hands, I will attempt to replace one (more self-destructive, ineffective) behaviour with another (more loving, intentional) behaviour. Secondly, perhaps practicing Mindfulness i.e. the intentional, momentary and non-judgemental awareness of the urges will help me feel more able to make a choice about whether to engage in the behaviours, or not – instead of mindlessly picking away at myself, unaware.